The Journal of Phytopharmacology 2021; 10(1): 35-41 Online at: www.phytopharmajournal.com Review Article Traditional Medicaments Combating Against ISSN 2320-480X Fibromyalgia- A Review JPHYTO 2021; 10(1): 35-41 January- February Vanshika Bhardwaj, Neha Gupta, Anju, Khusboo Arora, Avishek Kumar Jha, Abhishek Kumar, Priya Received: 14-12-2020 Accepted: 14-01-2021 Bansal* ©2021, All rights reserved doi: 10.31254/phyto.2021.10108 ABSTRACT Fibromyalgia syndrome is a persistent condition characterized by frequent body pain at different tender Vanshika Bhardwaj UG Scholar, KIET School of Pharmacy, points, sleep disturbance, fatigue, anxiety, impaired condition, joint stiffness. 5% of the world population KIET Group of Institutions, Delhi-NCR, mainly middle and old aged people suffer from it. Women are more prone towards this disease. The Ghaziabad, 201206, UP, India underlying pathophysiology of this syndrome is still unknown. Common symptoms of this syndrome mainly include chronic pain, fatigue, sleep disturbance, depression, joints stiffness, central sensitization, Neha Gupta UG Scholar, KIET School of Pharmacy, allodynia & hyperalgesia. There is no confirmatory blood test or imaging for diagnosis of fibromyalgia. KIET Group of Institutions, Delhi-NCR, The diagnosis criteria were set by The American College of Rheumatology (ACR) in 1990 and then Ghaziabad, 201206, UP, India modified further in 2010. The main drugs used for treatment mainly include Selective Serotonin Reuptake Inhibitor (SSRI) antidepressants, anticonvulsants, analgesics, Nonsteroidal anti-inflammatory drug, nerve Anju UG Scholar, KIET School of Pharmacy, pain medications and muscle relaxants. Therapies are also used for pain relieve such as acupuncture, KIET Group of Institutions, Delhi-NCR, graded exercise, stretching, massage, chiropractic treatment techniques, cognitive behavioural therapy, Ghaziabad, 201206, UP, India hydrotherapy, biofeedback and group support to overcome depression but they have low efficacy. Self- Khusboo Arora care is another major factor for treatment like stress management, healthy diet, relaxation techniques and UG Scholar, KIET School of Pharmacy, physical exercise. Due to various side effects of drugs, nowadays scientist and researchers having an eye KIET Group of Institutions, Delhi-NCR, on medicinal plants and their secondary constituents for treatment of fibromyalgia. In this review, authors Ghaziabad, 201206, UP, India tried to compile various medicinal plants and their secondary metabolites having potential to treat Avishek Kumar Jha fibromyalgia. UG Scholar, KIET School of Pharmacy, KIET Group of Institutions, Delhi-NCR, Keywords: Hyperalgesia, Depression, Anticonvulsant, Allodynia, Antidepressants. Ghaziabad, 201206, UP, India Abhishek Kumar Division of Pharmacology, KIET School INTRODUCTION of Pharmacy, KIET Group of Institutions, Delhi-NCR, Ghaziabad, 201206, UP, Fibromyalgia Syndrome is a persistent condition, characterized by frequent body pain at different tender India [1] points, sleep disturbance, fatigue, anxiety, impaired condition, joint stiffness . Fibrositis term was used Priya Bansal in 1904 given by Gowers [2] then Fibromyalgia as “pain syndrome” concept was introduced by Graham in Division of Pharmacology, KIET School 1950 [3]. Later the “fibromyalgia” was coined by Smythe and Moldofsky in mid 1970s and tender points of Pharmacy, KIET Group of Institutions, [4, 5] Delhi-NCR, Ghaziabad, 201206, UP, were also identified by them . In US estimated prevalence rate was 6% to 15% that is five times more [6] India in women than men . Etiology and pathogenesis of fibromyalgia are still unknown. Familial genetic predisposition responsible for pain sensation due to certain genetic compounds like dopamine and serotonin. Sleep abnormalities is due to restorative delta wave sleep loss [7, 8]. Central sensitization and pain inhibitory pathways are considered mechanism involved in pain sensation. Neurotransmitters alteration leads to sensory signals processing in CNS [6]. Pain centralization occurs due to nociceptors (peripheral pain receptors) activation [9, 10]. Another involved mechanism in fibromyalgia is activation of glial cells which modulate pain transfer in spinal cord which is activated by several sore stimuli. They release some pro inflammatory nitric acid, cytokines, reactive oxygen species and prostaglandins that excite and delay hyperexcitability of spinal cord [11, 12, 13]. Other factor that influence pain are cognitive and affective psychological factors. Cognitive factor is responsible for headache and dependent on 2 cognitions self-efficacy (SE), and locus of control (LOC). Affective factor is dependent on emotional state and negative affect: anger, depression and anxiety [14]. Other affected area are respiratory mechanics, second rib, anterior cervical, suboccipital region and upper trapezius muscle. Women affected with fibromyalgia syndrome have lower thoracic movability, respiratory muscle toleration and pulmonary muscle strength. Lower pulmonary strength was related with low axillary movability also increased fatigue and extremely large number of functioning tender points [15]. There is no confirmatory diagnosis process, blood tests, imaging or any other method for evaluation and analysis of fibromyalgia syndrome. Early diagnosis system Correspondence: is based on symptoms and history of condition. On the basis of pain and tender points count pre-ACR Priya Bansal diagnosis system was made [16-19]. The American College of Rheumatology (ACR) 1990 set the criteria of Division of Pharmacology, KIET School of Pharmacy, KIET Group of Institutions, diagnosis on the basis of chronic widespread pain for regular 3 months or more on 11 tender points out of [17, 18] Delhi-NCR, Ghaziabad, 201206, UP, 18 [ar270]. 2011 ACR concept was based on “ABC indicators” that is (A) analgesic, (B) bilateral, India axial symmetric pain (C) chronic disease [20-23]. In 2016 ACR modified the diagnosis criteria on the basis Email: [email protected] of symptoms [24]. Fibromyalgia is most probably related with depression [25]. 35 The Journal of Phytopharmacology Treatment of fibromyalgia is done by Antidepressant drugs, most attenuate the number of tender points. Hence the authors have probably duloxetine and milnacipran is used as the inhibit reuptake of suggested that P. ginseng can be a possible choice of treatment for serotonin and balance norepinephrine [26-29]. Pregabalin anticonvulsant fibromyalgia. However further research is required to understand the drug is also used as it affects influx of calcium and release exact MOA behind its activity [43]. neuropeptides and excitatory amino acids [30]. Other drugs used are (TCA) tricyclic antidepressant (amitriptyline), SSRI’s Tramadol, Curcuma Longa (Zingiberaceae) cyclobenzaprine, strong opioids, Nonsteroidal anti-inflammatory drug (NSAID) [31-33]. Armodafinil and Modafinil are used to treat fatigue Curcuma longa also known as Haridra in Ayurveda is widely used in occurring due to fibromyalgia [34]. Therapies used in treatment of treatment of inflammatory bowel disease, rheumatoid arthritis etc. A fibromyalgia other than drugs are acupuncture (electro or manual) [35, study was performed by Ismael San Mauro Martin et al. on anti- 36]. Other method used by physiotherapists are massage, heat/manual inflammatory and antioxidant effect of Curcuma longa in fibromyalgia therapy, hydro therapy, exercise, pain management, electrotherapy [37- patient. A randomized, controlled, prospective study was performed in 39]. Cupping therapy is also given to patients for improvement in which 13 women participated aged between 30-60 years. The groups condition [40]. It was observed that drugs used for treatment of were divided into two parts, group 1 (G1) comprises 6 women and fibromyalgia produces side effects like dizziness, nausea and many group 2 (G2) consist of 7 women. The study was conducted for one more. Other treatment given like physiotherapy and acupuncture month where following specifications were observed such as diet, pain, doesn’t show high efficacy. According to current scenario medicinal anthropometric study, sleep, fatigue and additional symptoms and were plants and secondary metabolites are considered for treatment of evaluated on the basis of questionnaire. At the end of study, it was fibromyalgia syndrome because of their good efficacy and no or less observed that G1 with turmeric diet has reduced intensity of pain as side effects [41]. The main objective of this review article was to compared with G2. Hence the authors have suggested that Curcuma summarize the medicinal plants and secondary metabolites that may be longa can be used to treat fibromyalgia pain because of its anti- [44] used for treatment of fibromyalgia on the basis of their activity to inflammatory & antioxidant characteristics . ameliorate pain. Tamarix indica (Tamaricaceae) MEDICINAL PLANTS COMBATING FIBROMYALGIA Tamarix indica is the rich source of tannin, troupin, tamarixin, flavones, Zingiber officinale (Zingiberaceae) ellagic acid etc. These compounds have beneficial effect in dysentery, thrombosis, chronic diarrhea and allergy. An experiment was Zingiber officinale also known as Ginger is a perennial herbaceous performed to analyze the antinociceptive, anti-inflammatory and Indian plant. It has diverse medicinal properties, hence used for dietary antibacterial activities of methanolic extract of root of Tamarix indica purpose for many decades. The rhizome is a store house of many in Young Swisss albino